Individual
DOUGLAS BERNARD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1304 FAWCETT AVE, SUITE 100, TACOMA, WA 98402-1911
(253) 761-4200
(253) 383-3553
Mailing address
PO BOX 1535, TACOMA, WA 98401-1535
(253) 761-4200
(253) 383-3553
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10005095
WA
363AM0700X
Medical Physician Assistant
PA10005095
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215666
LABOR AND INDUSTRIES-TRA
WA
01
—
0249530
LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA
01
—
8862652
MEDICARE PIN-TRA PIERCE
WA
01
—
8862653
MEDICARE PIN-TRA KING
WA
01
—
8862654
MEDICARE PIN-UNION AVENUE OPEN MRI
WA
01
—
8943157
LABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA
01
—
8951854
LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA
01
—
P00428602
RR MEDICARE-TRA
WA
Enumeration date
12/01/2006
Last updated
01/31/2017
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